Out On The Couch
Written by: Muria Nisbett, LCSW
Edited by: Manny Kemphues, MA. AMFT
As we recognize October as national domestic violence awareness month, and we hold vigil for the 24 people per minute who experience rape, physical violence or stalking by an intimate partner in the United States (NDVH, 2019), let’s not forget the voices of those who may not have been included in these statistics and whose stories are still untold. According to the CDC, intimate partner violence (IPV) refers to physical, sexual, or psychological harm inflicted by a current or former partner or spouse (CDC, n.d.). For the LGBTQIA+ community, however, there is also an additional form of violence known as identity abuse (Woulfe & Goodman, 2019). Identity abuse takes place when a perpetrator threatens to out a survivor to family and/or an employer or restricts their access to supportive LGBTQIA+ communities (Woulfe & Goodman, 2019). “Identity abuse emphasizes LGBTQIA+ survivors’ marginalized position and denigrates an aspect of their identity that is already threatened by internalized, interpersonal, cultural, and structural heterosexism and gender oppression” (Woulfe & Goodman, 2019). This form of abuse is not formally recognized in the definition of intimate partner violence which further highlights the disconnect in the global understanding of how intimate partner violence affects sexual and gender minorities.
Discussions around intimate partner violence have been largely centered on the idea that perpetrators are males and victims are females, with both parties being heterosexual. However, research has indicated that intimate partner violence affects LGBTQIA+ relationships at the same or higher rates as heterosexual relationships (Cannon & Buttell, 2015). The National Intimate Partner and Sexual Violence Survey conducted by the Center for Disease Control found that 29 percent of heterosexual men have experienced rape, physical violence, or stalking by an intimate partner, compared to 37 percent of bisexual men. The same survey found that 61 percent of bisexual women, as compared to 35 percent of heterosexual women, have experienced the same (NCAVD, 2018). There are only a handful of studies that compare the prevalence of intimate partner violence in transgender and cisgender couples, but one study indicated that 31.1% of transgender people compared to 20.4% of cisgender people surveyed had ever experienced IPV in their lifetime (Brown & Herman, 2015). These numbers indicate that LGBTQIA+ individuals may be at an increased risk of IPV and may be in need of additional services and appropriate resources.
Access to Care
For many LGBTQIA+ survivors of sexual assault, the decision to seek care is often affected by the discrimination that continues to affect sexual and gender minorities. This ongoing discrimination makes them hesitant to seek help from law enforcement, hospitals, shelters, or rape crisis centers, which are the very resources that are supposed to help them (HRC, n.d.). The National Coalition of Anti-Violence Program surveyed victim advocates and found that 85 percent reported that they have worked with an LGBTQ+ survivor who was denied services based on their sexual orientation or gender identity (HRC, n.d.). This affects access to quality care. LGBTQ+ survivors of intimate partner violence report high rates of help-seeking through informal resources such as family, friends, and associates (Calton, Cattaneo & Gebhard, 2016). Not surprisingly, the healthcare system has been deemed less than helpful when it comes to meeting the needs of LGBTQIA+ IPV survivors.
In the helping professions, training on same gender IPV continues to fall short when compared to the training on heterosexual IPV. Many healthcare providers are not equipped to meet the needs of sexual expansive communities largely due to homophobic, biphobic, and transphobic attitudes. They tend to refute the seriousness of the violence based on the assumption that women are not violent to each other and that men can protect themselves. Additionally, male perpetrators in relationships with women were considered more dangerous and serious than perpetrators of any gender in same-sex relationships. Healthcare providers have been said to assess heterosexual female IPV survivors in a different manner that they assess a LGBQ+ survivor (Rollè, Giardina, Caldarera, Gerino & Brustia, 2018).
Mental and sexual health implications
Intimate partner violence can lead to poor sexual and mental health outcomes for survivors. IPV is associated with lower levels of sexual satisfaction, greater likelihood of sexual dysfunctions, and sexual distress in cisgender women (Hellemans, Loeys, Buysse, Dewaele & De Smet, 2015). Aggression towards an intimate partner has also been strongly associated with a range of mental health problems. One study reported that lesbian IPV survivors reported significantly higher rates of daily stress, increased depression, and high rates of alcohol abuse (Hellemans, et al., 2015). A subsequent study conducted on 817 men who have sex with men found that IPV survivors were more likely to report depression, bipolar disorder, and other mental health disorders (Hellemans, et al., 2015).
While there are many barriers to care for LGBTQIA+ survivors of IPV, there are some resources available to assist and provide appropriate care. Additionally, there are many organizations that provide affirmative training for mental health professionals to ensure that they can provide the highest level of care to their LGBTQIA+ clients. The American Psychological Association also outlines 21 practice guidelines for working with LGBTQIA+ clients to ensure the provision of affirmative care (APA, 2012). Below are some organizations that provide trainings and resources for care.
- FORGE is a national transgender anti-violence organization that works with transgender survivors of sexual assault, domestic and dating violence, and stalking. They can be reached at their helpline 414-559-2123 or online.
- The Network/La Red is a survivor-led social justice organization that works to end partner abuse in lesbian, gay, bisexual, transgender, SM, polyamorous, and queer communities. They can be reached at their toll-free hotline 800-832-1901, or online at tnlr.org.
- Loveisrespect.org serves to engage, educate, and empower young people to prevent and end abusive relationships. They can be reached by phone or text at 1-866-331-99474 (24/7) or Text “loveis” to 22522.
- The Trevor Project is a non-judgmental hotline with LGBTQ-sensitive trained counselors you can contact through a call, text, or chat during a mental health crisis and/or when experiencing suicidal thoughts. They can be reached on their hotline at 1-866-488-7386. You can also chat online on their website at thetrevorproject.org/get-help-now/#tt.
- Trans Lifeline is a 24/7 hotline staffed by transgender people for transgender people. Trans Lifeline is primarily for assistance with crisis, from struggling with gender identity to thoughts of self-harm. They can be reached at 1-877-565-8860.
- The GLBT National Help Center provides telephone, online chat, and email peer support for many issues such as bullying, workplace issues, HIV/AIDS anxiety, coming out, relationships, safer sex, and more. They can be reached on their hotline at 1-888-843-4564, or for online peer support chat at glbthotline.org/chat.html.
- The LA LGBT Center is one of the few in the country that offers mental health services, including survivor groups and court-approved batterer intervention, and legal services specifically designed for LGBTQIA+ community members. For more information, go to lalgbtcenter.org/health-services/mental-health/intimate-partner-domestic-violence
This is not an exhaustive list, but it is intended some provide resources that can be accessed during an emergency.
Learn More About Working with LGBTQ Clients
American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. The American Psychologist, 67(1), 10.
Brown, T., & Herman, J. (2015). Intimate partner violence and sexual abuse among LGBT people. Los Angeles, CA: The Williams Institute.
Cannon, C., & Buttell, F. (2015). Illusion of inclusion: The failure of the gender paradigm to account for intimate partner violence in LGBT relationships. Partner Abuse, 6 (1), 65-77.
Calton, J. M., Cattaneo, L. B., & Gebhard, K. T. (2016). Barriers to help seeking for lesbian, gay, bisexual, transgender, and queer survivors of intimate partner violence. Trauma, Violence, & Abuse, 17(5), 585-600.
Center for Disease Control and Prevention. (N.D.). Intimate partner Violence. Retrieved from: https://www.cdc.gov/violenceprevention/intimatepartnerviolence/
Hellemans, S., Loeys, T., Buysse, A., Dewaele, A., & De Smet, O. (2015). Intimate partner violence victimization among non-heterosexuals: Prevalence and associations with mental and sexual well-being. Journal of Family Violence, 30(2), 171-188.
Human Rights Campaign. (N.D.). Sexual assault and the LGBTQ community. Retrieved from: https://www.hrc.org/resources/sexual-assault-and-the-lgbt-community
National Coalition Against Domestic Violence. (2018). Domestic violence and the LGBTQ community. Retrieved from: https://ncadv.org/blog/posts/domestic-violence-and-the-lgbtq-community
Rollè, L., Giardina, G., Caldarera, A. M., Gerino, E., & Brustia, P. (2018). When intimate partner violence meets same sex couples: A review of same sex intimate partner violence. Frontiers in psychology, 9
Woulfe, J., & Goodman, L. (2019). Weaponized oppression: Identity abuse and mental health in the lesbian, gay, bisexual, transgender, and queer community.. Psychology of Violence. 10.1037/vio0000251.